Middle America Meets Central Europe

Tag Archives: Endogenous depression

Is your main friend someone who’s an old acquaintance of ours?– Bob Dylan

I was diagnosed in 2002 with endogenous depression. In retrospect, I could recall many times over the previous twenty-five years when I had been in depressive episodes: Feeling no emotion at getting accepted to every graduate school I had applied for. Deciding that leaving my graduate program was the only solution to my inexplicable dissatisfaction. (If nothing is right, everything is wrong, so maybe changing everything will work?) Arriving in scenic Austria for the first time and not being able to take my nose out of the paperback thriller that gripped me and scared me—at least that was a glimmer of feeling. Getting invited to celebrate my birthday at a beer garden with my students and not being able to convince myself that they didn’t mean it ironically, that they weren’t taunting my obvious inability to enjoy myself by making me pretend I was. Walking across campus to teach a graduate class and suddenly realizing that I did not care one bit whether anybody learned anything, and feeling trapped because I was not insane enough just to give up.

Over that quarter century, I had enjoyed a lot of things, and accomplished a lot of things, including getting married to a wonderful woman and having a wonderful son. Getting a good job. Regular stays in Europe. Articles published, an editorship. The marvelous continual contact with youth and change that the university affords. But there were always those episodes that broke it up, completely illogical, out of all proportion to my actual misfortune (which was little) and my actual reasons for satisfaction (which were many).

Luckily, in 2002 we (my wife, my therapist, my doctor, and I) arrested the progress of the disease before it broke me. Fortunately, I responded immediately to the amitryptiline I was prescribed, and I found out that sleeping through the night was not an unattainable luxury. I could hear music better and see objects more clearly. I recall two symbolic moments in my recovery. The first was attending the meeting where my promotion to full professor was announced, and not feeling a trace of that old irony, that sense that if they only knew how little I deserve this! The second was walking into a gallery room at MOMA and suddenly seeing four large Gerhard Richter seascapes, each taking up a wall. I wept spontaneously. For joy.

Gerhard Richter, Seestück (Gegenlicht) / Seascape (Contre-jour) 1969

I had actually self-diagnosed long before this, but didn’t think I was in bad enough shape to seek professional treatment. This of course is part of the disease: if you think you’re not worth much, you’re certainly not worth using up other people’s time. I found a book in a Salzburg bookstore in 1990: Depression as Opportunity. The opportunity part didn’t impress me, but the symptoms listed all matched, except for suicidal thoughts and loss of appetite. I quit caffeine and started caffeine again. I numbed myself with doses of alcohol, not enough to depress me more, but enough to cut the anxiety. At some point I started to take St. John’s wort—and it worked for a while. Or maybe not—it might have been normal remission. I had anxiety-related conditions like shingles and prostatitis. Once I found a chart listing points for stressful life events and added mine up: I was a candidate for hospitalization. But I wasn’t in the hospital, which of course proved them wrong.

Then in the fall of 2001, everything seemed to be leaving me. Loss and fear of loss were the tenor of my life. The only time I felt the least bit whole was when playing music with others. And then that too seemed threatened by loss, and became the the worst source of pain instead of the only source of healing. One night I could not sleep and could not stop crying. (How hard that is to write!) My wife gave me specific instructions: make an appointment with a therapist we knew. Make an appointment with my doctor. I did. What a relief to have someone else—a professional—confirm what I had surmised, guessed, feared, and known at some level all those years. I was a diligent patient. In time I even asked to have my dosage upped by half. (In sixteen years, I can remember only one day I didn’t take my pills because I had forgotten them on an overnight trip.) I was lucky. I read Andrew Solomon’s The Noonday Demon: An Atlas of Depression and William Styron’s Darkness Visible and saw that my case was not so bad. I experienced recurrences, disthymia, flat affect, unfocused anxiety, but I always remembered what it was like not to be depressed, and I had learned it would pass.

So I was living my life for the most part with vigor and purpose. I started to put other aspects of my life in order, including my general health, although there are still loose ends even now. I enjoyed my job. I stayed productive, and really thought I was making a difference when I taught young people. I went six years with only minor and temporary depressive events. I thought I was in permanent recovery.

But that spring of 2008, stresses were mounting. The general morale at the university was suffering under administrative changes. Three of us were trying to do the same work that seven people had done only a few years earlier. I had agreed to help a colleague out with a demanding project because the project was so worthwhile. It didn’t occur to me to say no.

And that should have been a signal to me that all was not right. I had no right to say no. My interests were insignificant compared to those of others who seemed to have a reason for what they were doing. There were other signals: snapping at a colleague for what I assumed was a criticism, which was nothing of the sort. Dwelling on perceived slights two or three or more years old. Creating an iTunes playlist titled “Melancholia.” Organizing an outreach program for 400 high-school students and feeling nothing when it was over: no satisfaction, no relief, nothing but a grudging wonder that anyone might have enjoyed the thing. Widespread plagiarism in a class made me doubt the entire efficacy and purpose of education as I wavered between feeling like the students had wanted to dupe me and that they were irreparably dumb. I thought obsessively about retirement: how soon could I get out of this?

I had already taken steps—deciding to increase my dosage, calling my therapist—and had already had one therapy session before I viewed my disparate symptoms together and realized: the noonday demon was back. One morning before a therapy session I picked up Peter Kramer’s Against Depression and thought I was reading about other people with depression when I came across that classic list of ten symptoms. I had five of them. And for much longer than the two weeks that puts you in the clinical range. I had been looking outside of me for the reasons I felt so bad, and there seemed to be enough of them. But suddenly I knew: this was different. This was inside of me. I was almost excited when I announced to my therapist that day that I had figured it out.

I know a lot about depression. I’ve had forty years of direct experience. I see it in others a lot, because I know and am related to afflicted people. I’ve read a lot about it. I accepted the fact that I had it and, with help, put myself on the road to recovery. And even though I had all the evidence in front of me, I still didn’t see that I was in a full-blown episode. I thought I had put that behind me.

With therapy and an increased dosage I quickly stabilized. Feeling better again, I realize how long—at least three months—I was so far gone that I had forgotten what feeling good is. Not euphoric, not always cheery, but with an even chance to make life work. I have a new-found respect for the demon, that old acquaintance of ours. And even more resolve not to let him back up out of the basement again.